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Simultaneous Bacteriologic Assessment of Bile From Gallbladder and Common Bile Duct in Control Subjects and Patients With Gallstones and Common Duct Stones

Simultaneous Bacteriologic Assessment of Bile From Gallbladder and Common Bile Duct in Control... Abstract Objectives: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bateriologic findings. Methods: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultraneously for aerobic and anaerobic cultures. Results: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. Conclusions: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.(Arch Surg. 1996;131:389-394) References 1. Pitt HA, Postier RG, Cameron JL. Biliary bacteria: significance and alterations after antibiotic therapy . Arch Surg . 1982;117:445-449.Crossref 2. Brismar B, Jalakas K, Malmborg AS, Strandberg A. The significance of bacteriological findings at cholecystectomy . Acta Chir Scand . 1986;530: 35-38. 3. Martin LF, Zinner SH, Kagan JP, Zametkin AJ, Garrity FL, Fry DE. Bacteriology of the human gallbladder in cholelithiasis and cholecystitis . Am Surg . 1983; 49:151-153. 4. Delikaris PG, Michail PO, Klonis GD, Haritopoulos NC, Golematis BC, Dreiling DA. Biliary bacteriology based on intraoperative bile cultures . Am J Gastroenterol . 1977;68:51-55. 5. Claesson B, Holmlund D, Mätzsch T. Biliary microflora in acute cholecystitis and the clinical implications . Acta Chir Scand . 1985:150:229-237. 6. Willis RG, Lawson WC, Hoare EM, Kingston RD, Sykes PA. Are bile bacteria relevant to septic complications following biliary surgery? Br J Surg . 1984; 71:845-849.Crossref 7. Sianesi M, Ghirarduzzi A, Percudani M, Dell Anna B. Cholecystectomy for acute cholecystitis: timing of operation, bacteriologic aspects, and postoperative course . Am J Surg . 1984;148:609-612.Crossref 8. Claesson BE, Holmlund DEW, Mätzsch TW. Microflora of the gallbladder related to duration of acute cholecystitis . Surg Gynecol Obstet . 1986;162:531-535. 9. Edlund YA, Mollstedt BO, Ouchterlony O. Bacteriological investigations of the biliary system and liver in biliary tract disease correlated to clinical data and microstructure of the gallbladder and liver . Acta Chir Scand . 1958-1959:66: 461-476. 10. Keighley MRB, Flinn R, Alexander-Williams J. Multivariate analysis of clinical and operative findings associated with biliary sepsis . Br J Surg . 1976:63:528-531.Crossref 11. Dye M, MacDonald AQ, Swith G. The bacterial flora at the biliary tract and liver in man . Br J Surg . 1978;65:287-289.Crossref 12. Keighley MRB, Lister DM, Jacobs SI, Giles GR. Hazards of surgical treatment due to microorganisms in the bile . Surgery . 1974;75:578-583. 13. Keighley MRB, Burdon DW. Identification of bacteria in the bile by duodenal aspiration . World J Surg . 1978;2:255-259.Crossref 14. Keighley MRB, McLeish AR, Bishop HM, et al. Identification of the presence and type of biliary microflora by immediate Gram stains . Surgery . 1977:81: 469-472. 15. Landau O, Kott I, Deutsch AA, Stelman E, Reiss R. Multifactorial analysis of septic bile and septic complications in biliary surgery . World J Surg . 1992; 16:962-965.Crossref 16. Cetta F. The route of infection in patients with bactibilia . World J Surg . 1983; 7:562-576.Crossref 17. Nielsen ML, Justensen T. Anaerobic and aerobic bacteriological studies in biliary tract disease . Scand J Gastroenterol . 1976;11:437-446. 18. Scott AJ, Khan GA. Origin of bacteria in bile duct bile . Lancet . 1967;2:790-792.Crossref 19. Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis . Br J Surg . 1992;79: 655-658.Crossref 20. Holdeman LV, Moore WEC. Anaerobic Laboratory Manual . Blacksbury, Va: Virginia Polytechnic Institute and State Institute University; 1972. 21. Csendes A, Fernandez M, Uribe P. Bacteriology of the gallbladder bile in normal subjects . Am J Surg . 1975;129:629-631.Crossref 22. Wunkhaus R, Antezana C, Rodrigo C, Palma R. Chemical composition of biliary stones among Chilean population . Rev Med Chil . 1973;101:355-359. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Simultaneous Bacteriologic Assessment of Bile From Gallbladder and Common Bile Duct in Control Subjects and Patients With Gallstones and Common Duct Stones

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430160047008
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bateriologic findings. Methods: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultraneously for aerobic and anaerobic cultures. Results: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. Conclusions: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.(Arch Surg. 1996;131:389-394) References 1. Pitt HA, Postier RG, Cameron JL. Biliary bacteria: significance and alterations after antibiotic therapy . Arch Surg . 1982;117:445-449.Crossref 2. Brismar B, Jalakas K, Malmborg AS, Strandberg A. The significance of bacteriological findings at cholecystectomy . Acta Chir Scand . 1986;530: 35-38. 3. Martin LF, Zinner SH, Kagan JP, Zametkin AJ, Garrity FL, Fry DE. Bacteriology of the human gallbladder in cholelithiasis and cholecystitis . Am Surg . 1983; 49:151-153. 4. Delikaris PG, Michail PO, Klonis GD, Haritopoulos NC, Golematis BC, Dreiling DA. Biliary bacteriology based on intraoperative bile cultures . Am J Gastroenterol . 1977;68:51-55. 5. Claesson B, Holmlund D, Mätzsch T. Biliary microflora in acute cholecystitis and the clinical implications . Acta Chir Scand . 1985:150:229-237. 6. Willis RG, Lawson WC, Hoare EM, Kingston RD, Sykes PA. Are bile bacteria relevant to septic complications following biliary surgery? Br J Surg . 1984; 71:845-849.Crossref 7. Sianesi M, Ghirarduzzi A, Percudani M, Dell Anna B. Cholecystectomy for acute cholecystitis: timing of operation, bacteriologic aspects, and postoperative course . Am J Surg . 1984;148:609-612.Crossref 8. Claesson BE, Holmlund DEW, Mätzsch TW. Microflora of the gallbladder related to duration of acute cholecystitis . Surg Gynecol Obstet . 1986;162:531-535. 9. Edlund YA, Mollstedt BO, Ouchterlony O. Bacteriological investigations of the biliary system and liver in biliary tract disease correlated to clinical data and microstructure of the gallbladder and liver . Acta Chir Scand . 1958-1959:66: 461-476. 10. Keighley MRB, Flinn R, Alexander-Williams J. Multivariate analysis of clinical and operative findings associated with biliary sepsis . Br J Surg . 1976:63:528-531.Crossref 11. Dye M, MacDonald AQ, Swith G. The bacterial flora at the biliary tract and liver in man . Br J Surg . 1978;65:287-289.Crossref 12. Keighley MRB, Lister DM, Jacobs SI, Giles GR. Hazards of surgical treatment due to microorganisms in the bile . Surgery . 1974;75:578-583. 13. Keighley MRB, Burdon DW. Identification of bacteria in the bile by duodenal aspiration . World J Surg . 1978;2:255-259.Crossref 14. Keighley MRB, McLeish AR, Bishop HM, et al. Identification of the presence and type of biliary microflora by immediate Gram stains . Surgery . 1977:81: 469-472. 15. Landau O, Kott I, Deutsch AA, Stelman E, Reiss R. Multifactorial analysis of septic bile and septic complications in biliary surgery . World J Surg . 1992; 16:962-965.Crossref 16. Cetta F. The route of infection in patients with bactibilia . World J Surg . 1983; 7:562-576.Crossref 17. Nielsen ML, Justensen T. Anaerobic and aerobic bacteriological studies in biliary tract disease . Scand J Gastroenterol . 1976;11:437-446. 18. Scott AJ, Khan GA. Origin of bacteria in bile duct bile . Lancet . 1967;2:790-792.Crossref 19. Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis . Br J Surg . 1992;79: 655-658.Crossref 20. Holdeman LV, Moore WEC. Anaerobic Laboratory Manual . Blacksbury, Va: Virginia Polytechnic Institute and State Institute University; 1972. 21. Csendes A, Fernandez M, Uribe P. Bacteriology of the gallbladder bile in normal subjects . Am J Surg . 1975;129:629-631.Crossref 22. Wunkhaus R, Antezana C, Rodrigo C, Palma R. Chemical composition of biliary stones among Chilean population . Rev Med Chil . 1973;101:355-359.

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1996

References